Societal changes and the etiology of stone disease

Signi ficant advances have taken place in medicine over the past century. In addition, increasing rates of obesity, diabetes mellitus, and metabolic syndrome have resulted in increasing rates of stones among men and women. Within 1 year of forming a calcium oxalate stone, 10 % of men will form another calcium oxalate stone, and 50 % will form another stone within 10 years. Males are affected three times as frequently as females for stones. Testosterone clearly has an impact on this; however, the rates of nephrolithiasis among women are increasing. Urine studies have demonstrated a decrease in urinary pH (>5.5) and an increase in uric acid supersaturation. This has resulted in increased rates of uric acid stones. In addition, obesity surgery has increased the risk of calcium oxalate stone formation. All of these factors combined have had a profound in fl uence on the patterns of stone disease. Lifestyles have signi ficantly affected the prevalence of kidney stone disease. In this chapter, we will review the impact of societal changes on stone patterns.